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A comparison of Reinforcement Based Treatment (RBT) versus RBT plus Recovery Housing (RBT RH) (Tuten et al., 2017)

Review Guidelines

Absence of conflict of interest. 

Citation

Tuten, M., Shadur, J. M., Stitzer, M., & Jones, H. E. (2017). A comparison of Reinforcement Based Treatment (RBT) versus RBT plus Recovery Housing (RBT RH). Journal of Substance Abuse Treatment, 72, 48-55. http://dx.doi.org/10.1016/j.jsat.2016.09.001

Highlights

  • The study's objective was to examine the impact of recovery housing on employment and earnings for individuals with opioid use disorders receiving Reinforcement Based Treatment (RBT). 
  • Using data collected through the Addiction Severity Index (ASI) Assessment, the authors conducted a nonexperimental study to compare the outcomes of individuals with opioid use disorders receiving RBT with recovery housing to a comparison group receiving only RBT.  
  • The study suggested there was no relationship between recovery housing and employment for individuals with opioid use disorders receiving RBT. 
  • The quality of causal evidence presented in this report is low because the authors did not account for other factors that could have affected the difference between the treatment and comparison groups. This means we are not confident that the estimated effects are attributable to the intervention; other factors are likely to have contributed. 

Intervention Examined

Reinforcement Based Treatment plus recovery housing

Features of the Intervention

Reinforcement Based Treatment (RBT) is a psychosocial intervention for individuals with substance use disorders. RBT is an intensive outpatient behavioral program that includes functional assessments of substance use, individualized counseling, behavior graphing, program-supported recreational activities, intensive vocational training, peer reinforcement, motivational interviewing feedback, and contingency management. RBT plus Recovery Housing (RBTRH) uses these same approaches combined with recovery housing. Recovery housing is used as a transition to independent living for individuals with substance use disorders after inpatient or residential treatment. Studies have shown that RBTRH helps people stay drug-free and find employment. 

Features of the Study

This study uses a nonexperimental design. Using regression analysis, the authors compared the outcomes of a group who received outpatient RBT only (the comparison group) to a group that received outpatient RBT plus Recovery Housing (the treatment group).    

Both groups attended a 24-week outpatient treatment program. They received individual counseling 2-3 times each week and attended outpatient services every day for the first four weeks, four days a week for weeks four through twelve, and twice a week for the last twelve weeks. Participants were monitored on their progress toward a minimum of four goals such as attendance, drug abstinence, employment seeking, or recreational activities. Urine testing and breath testing for drugs and alcohol were collected at each visit.   

The treatment group received RBT plus 12 weeks of paid recovery housing contingent on abstinence from opioids. The treatment group sample was drawn from a randomized condition and recruited from April 10, 2001 to February 21, 2004. The comparison group received outpatient RBT and housing case management, but no recovery housing. The comparison group sample was drawn from a non-randomized, longitudinal study and recruited from September 18, 2004 to May 24, 2006. A total of 135 individuals were recruited into the study from the same medical detoxification facility at Johns Hopkins Bayview Medical Center, with 55 in the comparison group and 80 in the treatment group. The treatment and comparison group samples were both drawn from the same medical detoxification units with the same eligibility criteria. Participants had similar drug use characteristics and demographics.  

Findings

Employment

  • The study suggested there was no relationship between recovery housing and employment for individuals with opioid use disorders receiving RBT. 

Considerations for Interpreting the Findings

The authors did not account for other factors that could have affected the difference between the treatment and comparison groups, such as participant motivation, need for housing, employment history, family financial support, childcare, and transportation. Therefore, the study is not eligible for a moderate causal evidence rating, the highest rating available for nonexperimental designs. 

Causal Evidence Rating

The quality of causal evidence presented in this report is low because the authors did not account for other factors that could have affected the difference between the treatment and comparison groups. This means we are not confident that the estimated effects are attributable to the intervention; other factors are likely to have contributed. 

Additional Sources

Tuten, M., DeFulio, A., Jones, H. E., & Stitzer, M. (2012). Abstinence-contingent recovery housing and reinforcement-based treatment following opioid detoxification. Addiction, 107, 973–982. http://dx.doi.org/10.1111/j.1360–0443.2011.03750.x.

Reviewed by CLEAR

September 2024